Does report of craving opioid medication predict aberrant drug behavior among chronic pain patients?

Clin J Pain. Mar-Apr 2009;25(3):193-8. doi: 10.1097/AJP.0b013e318193a6c4.


Objective: To examine the relationship between the self-report of craving prescription medication and subsequent opioid misuse among chronic pain patients prescribed opioids for pain.

Methods: Six hundred thirteen patients taking opioid medication for chronic noncancer pain were asked how often they have felt a craving for their medication on a scale from 0=never to 4=very often. All participants completed a series of baseline questionnaires. After 6 months the participants were administered a structured prescription drug use interview (Prescription Drug Use Questionnaire), and submitted a urine sample for toxicology assessment. Their treating physicians also completed a substance misuse behavior checklist (Prescription Opioid Therapy Questionnaire).

Results: Three hundred thirty-seven participants (55.0%) reported that they never felt a craving for their medication, whereas 276 (45.0%) reported some degree of craving their medication (seldom to very often). Those who reported craving their medication were significantly more often male (P<0.01), unmarried (P<0.05), had lower scores on social desirability (P<0.001), and had been prescribed opioids for a longer time (P<0.05) than those who did not report craving medication. At 6-month follow-up, those who reported craving their medication showed higher scores on the Prescription Drug Use Questionnaire (P<0.001), had a higher incidence of physician-rated aberrant drug behavior on the Prescription Opioid Therapy Questionnaire (P<0.05), showed a higher frequency of abnormal urine toxicology screens (P<0.001), and more often had a positive Aberrant Drug Behavior Index (P<0.001).

Discussion: These results suggest that self-reported craving is a potential marker for identification of those at risk for opioid medication misuse.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / therapeutic use*
  • Analgesics, Opioid / urine
  • Chi-Square Distribution
  • Chronic Disease
  • Drug Users
  • Female
  • Humans
  • Male
  • Middle Aged
  • Opioid-Related Disorders / physiopathology*
  • Opioid-Related Disorders / psychology*
  • Opioid-Related Disorders / urine
  • Pain / drug therapy*
  • Pain / psychology*
  • Pain Measurement / methods
  • Predictive Value of Tests
  • Prescription Drugs / therapeutic use
  • Sex Factors
  • Surveys and Questionnaires
  • Young Adult


  • Analgesics, Opioid
  • Prescription Drugs